Intervention Review

Transcutaneous electrostimulation for osteoarthritis of the knee

  1. Anne WS Rutjes1,*,
  2. Eveline Nüesch1,
  3. Rebekka Sterchi1,
  4. Leonid Kalichman2,
  5. Erik Hendriks3,
  6. Manathip Osiri4,
  7. Lucie Brosseau5,
  8. Stephan Reichenbach6,
  9. Peter Jüni1

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 1 FEB 2009

DOI: 10.1002/14651858.CD002823.pub2

Database Title

Additional Information

How to Cite

Rutjes AWS, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, Brosseau L, Reichenbach S, Jüni P. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD002823. DOI: 10.1002/14651858.CD002823.pub2.

Author Information

  1. 1

    University of Bern, Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, Bern, Switzerland

  2. 2

    Ben-Gurion University of the Negev, Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Beer Sheva, Israel

  3. 3

    Maastricht University, Epidemiology Department, Maastricht, Netherlands

  4. 4

    Faculty of Medicine, Department of Medicine, Bangkok, Thailand

  5. 5

    University of Ottawa, School of Rehabilitation Sciences, Faculty of Health Sciences, Ottawa, Ontario, Canada

  6. 6

    University Hospital, Department for Rheumatology, Clinical Immunology, and Allergology, Bern, Switzerland

*Anne WS Rutjes, Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, 3012, Switzerland. arutjes@ispm.unibe.ch. a.rutjes@crc-cesi.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2010

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (67K)Standard (844K)Full (909K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in the elderly. Transcutaneous electrical nerve stimulation (TENS), interferential current stimulation and pulsed electrostimulation are used widely to control both acute and chronic pain arising from several conditions, but some policy makers regard efficacy evidence as insufficient.

Objectives

To compare transcutaneous electrostimulation with sham or no specific intervention in terms of effects on pain and withdrawals due to adverse events in patients with knee osteoarthritis.

Search methods

We updated the search in CENTRAL, MEDLINE, EMBASE, CINAHL and PEDro up to 5 August 2008, checked conference proceedings and reference lists, and contacted authors.

Selection criteria

Randomised or quasi-randomised controlled trials that compared transcutaneously applied electrostimulation with a sham intervention or no intervention in patients with osteoarthritis of the knee.

Data collection and analysis

We extracted data using standardised forms and contacted investigators to obtain missing outcome information. Main outcomes were pain and withdrawals or dropouts due to adverse events. We calculated standardised mean differences (SMDs) for pain and relative risks for safety outcomes and used inverse-variance random-effects meta-analysis. The analysis of pain was based on predicted estimates from meta-regression using the standard error as explanatory variable.

Main results

In this update we identified 14 additional trials resulting in the inclusion of 18 small trials in 813 patients. Eleven trials used TENS, four interferential current stimulation, one both TENS and interferential current stimulation, and two pulsed electrostimulation. The methodological quality and the quality of reporting was poor and a high degree of heterogeneity among the trials (I2 = 80%) was revealed. The funnel plot for pain was asymmetrical (P < 0.001). The predicted SMD of pain intensity in trials as large as the largest trial was -0.07 (95% CI -0.46 to 0.32), corresponding to a difference in pain scores between electrostimulation and control of 0.2 cm on a 10 cm visual analogue scale. There was little evidence that SMDs differed on the type of electrostimulation (P = 0.94). The relative risk of being withdrawn or dropping out due to adverse events was 0.97 (95% CI 0.2 to 6.0).

Authors' conclusions

In this update, we could not confirm that transcutaneous electrostimulation is effective for pain relief. The current systematic review is inconclusive, hampered by the inclusion of only small trials of questionable quality. Appropriately designed trials of adequate power are warranted.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Transcutaneous electrostimulation for osteoarthritis of the knee

This summary of a Cochrane review presents what we know from research about the effect of transcutaneous electrostimulation on osteoarthritis of the knee.

The review shows that in people with osteoarthritis:

- We are uncertain whether transcutaneous electrostimulation affects pain or your ability to use your knee because of the very low quality of the evidence.  
- Transcutaneous electrostimulation may not have any side effects. We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. 

 

What is osteoarthritis and what is transcutaneous electrostimulation?

Osteoarthritis (OA) is a disease of the joints, such as your knee. When the joint loses cartilage, the bone grows to try and repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. For example, the bone can become misshapen and make the joint painful and unstable.  This can affect your physical function or ability to use your knee.

Transcutaneous electrostimulation, such as TENS, is a kind of pain relief typically using electrical currents applied to the skin. Transcutaneous electrostimulation machines are typically small, battery-operated machines with 2 electrodes attached.  Electrodes are wires that send the electrical current.  Usually, you connect two electrodes from the machine to your skin on the painful area. Your doctor or physiotherapist will show you how to use it, and most machines can be used at home.

 

Best estimate of what happens to people with osteoarthritis who use transcutaneous electrostimulation up to 4 weeks after using it:

Pain

- People who used electrostimulation had an improvement in their pain of about 2 on a scale from 0 (no pain) to 10 (extreme pain) 4 weeks after using it.

- People who used a fake electrostimulation machine or just took their usual treatments had an improvement in their pain of about 2 on a scale from 0 (no pain) to 10 (extreme pain) 4 weeks after using it.

- People had no more average improvement when using electrostimulation, and no more people responded to treatment with electrostimulation compared with people who used a fake electrostimulation machine or just took their usual treatments (difference of 0%).

 

Physical Function

- People who used electrostimulation had an improvement in their physical function of about 2 on a scale from 0 (no disability) to 10 (extreme disability) 4 weeks after using it.

- People who used a fake electrostimulation machine or just took their usual treatments had an improvement in their physical function of about 1 on a scale from 0 (no disability) to 10 (extreme disability) 4 weeks after using it.

- People using electrostimulation had 1 unit more improvement in their knee function when compared to people who used a fake electrostimulation machine or just took their usual treatments.

Another way of saying this is:

- 29 people out of 100 who used electrostimulation respond to treatment (29%).

- 26 people out of 100 who used a fake electrostimulation machine or just took their usual treatments respond to treatment (26%).

- 3 more people respond to treatment with electrostimulation compared with people who used a fake electrostimulation machine or just took their usual treatments (difference of 3%).

 

Dropouts or withdrawals from the trial because of side effects

- 2 people out of 100 who used electrostimulation dropped out or withdrew from the trial because of side effects (2%).

- 2 people out of 100 who used a fake electrostimulation machine or just took their usual treatments dropped out of the trial because of side effects (2%).

- There was no difference in the number of people who dropped out of the trial because of side effects (difference of 0%). This could be the result of chance.

 

Side effects

- 15 people out of 100 who used electrostimulation experienced side effects (15%).

- 15 people out of 100 who used a fake electrostimulation machine or just took their usual treatments experienced side effects (15%).

- There was no difference in the number of people who experience side effects (difference of 0%). This could be the result of chance.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

經皮電刺激治療膝退化性關節炎

退化性關節炎是老人常見造成疼痛及行動不便的主要原因。經皮電刺激(Transcutaneous electrical nerve stimulation, TENS干擾波電流刺激及間歇性電流刺激interferential current stimulation and pulsed electrostimulation)廣泛用於治療急性及慢性疼痛，但有些決策者認為證據未充分。

目標

研究比較經皮電刺激與假性治療，或者未進行治療在膝部退化性關節炎疼痛效果及因副作用而導致的退出。

搜尋策略

搜尋包括CENTRAL、MEDLINE、EMBASE、CINAH 與PEDro (直到2008年8月)，同時手動搜尋文章之參考文獻，研討會論文，及詢問作者。

選擇標準

隨機或擬隨機試驗比較經皮電刺激與假性治療，或者未進行治療在膝部退化性關節炎之研究。

資料收集與分析

作者以標準化表單進行資料摘錄，並聯絡研究者有關資料流失部分。主要研究結果為疼痛及因副作用的退出。疼痛方面計算標準化平均差異(standardised mean difference, SMD)，安全性結果方面用相對風險表示，並使用使用變異數倒數隨機效果進行統合分析)。疼痛是以標準誤當解釋變數之總迴歸分析預測估計值做分析。

主要結論

在這項更新中新增了14項其他試驗總共18個小臨床試驗中含813位患者的。其中11篇使用TENS，4篇使用干擾波電流刺激，1篇同時使用經皮電刺激與干擾波電流刺激，2篇使用間歇性電流刺激。方法品質及報告品質為不佳，且各研究之間有異質性(I2 = 80%)。漏斗圖為不對稱(P < 0.001)。疼痛強度結果之標準化平均差異為 −0.0 95% 信賴區間CI −0.46 to 0.32)，相當於電流刺激與控制組之10cm視覺類比量表VAS差異為0.2公分。電流刺激形式也無標準化平均差異上顯著差異(P = 0.94)。副作用而退出相對風險為0.97 (95% 信賴區間CI 0.2 to 6.0)。

作者結論

無法證明電流刺激對於疼痛緩解有效，系統性回顧結果因僅納入小樣本及低品質研究而未有結論。需要適當研究設計及檢定力的研究。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

■ 經皮電刺激治療膝退化性關節炎。這篇Cochrane回顧由研究中，介紹以經皮電刺激治療膝退化性關節炎的療效。 ■這篇回顧顯示對於退化性關節炎患者：  由於證據的品質過低，我們不確定是否經皮電刺激會對疼痛或是使用膝蓋的能力造成影響。  經皮電刺激也許沒有副作用。我們沒有任何關於副作用與併發症明確的資訊，特別是罕見但是嚴重的副作用。 ■什麼是退化性關節炎？什麼是經皮電刺激？退化性關節炎(OA) 是一種關節(如膝蓋)的疾病。當關節軟骨流失，則骨頭會生長以修復損害。骨頭以不規則的方式生長，這樣非但沒有幫助，反而讓情況更糟。譬如骨頭可能會畸形並且讓關節疼痛、不穩定。這可能影響身體功能以及關節使用能力。 經皮電刺激(如TENS)是一種疼痛緩解方式，通常是將電流用於皮膚之上。經皮電刺激的設備通常很小、使用電池操作，並附有兩個電極。電極是可以傳送電流的導線。 通常是將兩極從機器連接到疼痛部位的皮膚上。 醫師或是物理治療師將會教導如何使用，而多數的機器可以在家使用。 ■ 最佳估算退化性關節炎病人使用經皮電刺激治療的時間為使用4周後: ■疼痛  使用電流刺激4周者，可改善疼痛指數2分(尺度為0分不疼痛10分極度疼痛)。  使用假電流刺激4周者或進行一般治療，可改善疼痛指數2分(尺度為0分不疼痛10分極度疼痛)。  經皮電刺激與假治療、或是一般治療相比，再也沒有獲得更多改善，也沒有更多人對於經皮電刺激治療有反應，(差異0%)。 ■身體功能  以經皮電刺激治療4個星期，可以改善其身體功能2分(尺度是從0分無失能∼10分重度失能)。  以假治療或是使用一般的治療4個星期，可以改善其身體功能1 分(尺度是從0分無失能∼10分重度失能)。  使用經皮電刺激相較於假治療、使用一般治療者，可以改善一個單位的膝功能。 ■其他方面如下: 每100人中有29人對經皮電刺激治療有反應(29%)。  每100人中有26人對假治療或一般治療有反應(26%)。 經皮電刺激較假治療或一般治療多出了3位有反應者(差異3%)。 ■因副作用而退出  使用經皮電刺激，每100人有2人因副作用退出(2%)。  使用假治療或一般治療，每100人有2人因副作用退出(2%)。  因副作用退出試驗的人數沒有差異(差異0%)。 這可能是偶然發生的結果。 ■副作用  每100人當中有15人感受到副作用(15%)。

View Full Article (HTML) Summary (67K)Standard (844K)Full (909K)